Dr. Stephanie Auerbach, ND | Hawthorn Healing Arts
Bloating after nearly every meal. A stomach that seems to expand as the day goes on. Constipation one week, diarrhea the next. Brain fog, fatigue, abdominal discomfort, and a growing list of foods that suddenly seem impossible to tolerate.
Many people living with these symptoms are eventually told they have irritable bowel syndrome (IBS), yet they still don’t feel like they have real answers. Increasingly, researchers and clinicians are discovering that for many of these individuals, another condition may be contributing to their symptoms: Small Intestinal Bacterial Overgrowth, better known as SIBO. The encouraging news is that SIBO is something we can evaluate, treat, and—perhaps most importantly—investigate to determine why it developed in the first place.
What Is SIBO?
Your digestive tract is home to trillions of microorganisms that play an essential role in digestion, immune function, and overall health. Most of these bacteria belong in the large intestine, where they help break down food and support a healthy microbiome. The small intestine is different. Its primary job is to digest food and absorb nutrients before they enter the bloodstream. Under normal circumstances, relatively few bacteria live there.
With SIBO, bacteria that normally reside farther down the digestive tract begin accumulating in the small intestine. The bacteria themselves are not necessarily “bad”—they’re simply in the wrong place. Once there, they begin fermenting carbohydrates before your body has had a chance to properly digest and absorb them. That fermentation produces gases such as hydrogen or methane, which can trigger many of the uncomfortable symptoms people experience.
Common Symptoms of SIBO
Because SIBO affects digestion, symptoms often appear after eating and can vary considerably from person to person. Some of the most common symptoms include:
- Abdominal bloating or visible distention
- Excess gas or belching
- Abdominal pain or cramping
- Constipation
- Diarrhea
- Alternating constipation and diarrhea
- Nausea
- Feeling overly full after small meals
- Fatigue
- Brain fog
Over time, poor absorption of nutrients may also contribute to vitamin deficiencies, weakness, and reduced energy levels.
Why Does SIBO Develop?
One of the biggest misconceptions about SIBO is that it simply “happens.” In reality, SIBO is often a clue that something else has disrupted the normal function of the digestive tract. Think of your small intestine as having its own housekeeping crew. Between meals, gentle waves of muscle contractions—known as the migrating motor complex—sweep leftover food particles and bacteria through the digestive tract.
When that natural cleaning process slows down, bacteria have an opportunity to linger, multiply, and gradually move into areas where they don’t belong. Several factors may contribute to this process, including:
- Irritable bowel syndrome (IBS)
- Previous episodes of food poisoning
- Slowed intestinal motility
- Low stomach acid
- Certain acid-suppressing medications
- Thyroid disorders
- Abdominal surgery or scar tissue
- Other digestive disorders affecting normal movement through the intestines
This is why simply reducing the bacterial overgrowth isn’t always enough. If the underlying reason for the overgrowth isn’t identified, symptoms are more likely to return.
Not Everyone Experiences SIBO the Same Way
One person’s SIBO may look completely different from another’s. Some bacteria produce mostly hydrogen gas, which is often associated with loose stools or diarrhea. Others produce methane, which tends to slow intestinal movement and contribute to constipation. Some individuals produce a combination of gases and experience both symptoms. Understanding which gases are present can provide valuable information when developing a treatment plan.
How Is SIBO Diagnosed?
Fortunately, testing for SIBO is relatively straightforward. One of the most commonly used tools is a hydrogen and methane breath test, which can often be completed from the comfort of your own home. After drinking a specially prepared lactulose solution, you collect breath samples at regular intervals over several hours. The laboratory measures hydrogen and methane levels to determine whether excessive fermentation is occurring within the small intestine.
This information helps identify whether SIBO is present and provides important clues that help guide treatment decisions. Rather than guessing, testing allows your healthcare provider to create a more personalized treatment strategy.
Treatment Is More Than Eliminating Bacteria
One of the reasons SIBO has earned a reputation for recurring is that treatment sometimes focuses only on reducing bacteria without addressing the underlying cause. Treatment plans often include several components working together. For some individuals, prescription antibiotics such as rifaximin may be appropriate. While rifaximin has been well studied, it can also be quite expensive depending on insurance coverage.
Many naturopathic physicians also utilize carefully selected herbal antimicrobial protocols. Herbs such as oregano, berberine-containing plants, garlic derivatives, pomegranate, black cumin, and cinnamon have all been studied for their antimicrobial properties. However, different bacteria respond differently to various botanicals, making individualized treatment far more effective than simply purchasing a supplement online. Improving intestinal motility, supporting normal digestive function, and identifying contributing factors are equally important pieces of successful treatment.
Does Diet Matter?
Absolutely—but perhaps not in the way many people expect. During treatment, your healthcare provider may recommend temporary dietary modifications to reduce fermentation while the bacterial overgrowth is being addressed. For some individuals, this may include a lower-fermentation or modified low-FODMAP approach. The goal is not lifelong food restriction.
Instead, nutrition should gradually shift toward supporting a diverse, healthy microbiome while helping reduce the likelihood of future overgrowth. Every person’s digestive system is unique, so dietary recommendations should be tailored to the individual rather than copied from the latest trend circulating online.
Why Personalized Care Matters
Digestive symptoms can have many different causes, and not every case of bloating or abdominal discomfort is caused by SIBO. Likewise, not every person with SIBO requires the same treatment. A thorough evaluation—including a detailed health history, appropriate testing, and an understanding of the factors that may have contributed to the condition—allows treatment to be customized to your unique needs.
Rather than simply chasing symptoms, the goal is to restore healthy digestive function while reducing the chances that SIBO will return.
If you’re struggling with persistent bloating, unexplained digestive symptoms, or you’ve been told you have IBS without finding lasting relief, it may be time to look a little deeper. Dr. Auerbach takes a comprehensive, individualized approach to digestive health, helping patients uncover the root causes of chronic gastrointestinal symptoms and develop treatment plans designed for long-term wellness. To make an appointment with Dr. Auerbach call 541-330-0334 or feel free to use our online appointment form.